Acute respiratory failure requiring mechanical ventilation in an intensive care unit is common, affecting almost 800,000 people each year. With survival improving over time, research on quality of life among ICU survivors and their family members has become increasingly important. This research has primarily focused on the negative experiences of these survivors and their family members, including long-term symptoms of depression, anxiety and post-traumatic stress that occur in patient survivors and their family members. In cancer and trauma survivors, studies have shown that individuals may respond with psychological adaptations that enable them to experience positive change in the context of their illness. A better understanding of the factors that define and influence patient and family psychological adaptations to the experience of acute respiratory failure, as well as the association between these adaptations and patient and family outcomes such as quality of life, will provide a novel opportunity to develop interventions to improve outcomes for patients with acute respiratory failure and their family members. This application proposes to conduct a longitudinal cohort study of patients with acute respiratory failure and their family members to identify the contributing factors and outcomes associated with psychological adaptation including resilience, post-traumatic growth and benefit finding. We hypothesize that there will be characteristics of patients and family members, as well as processes of clinical care in the intensive care unit, that are associated with psychological adaptation after acute respiratory failure, and that enhanced psychological adaptation will be associated with improved long-term outcomes for both patients and their family members. The study aims to enroll 250 patients with acute respiratory failure and 250 family members, and will obtain in hospital assessments of demographics, psychosocial and behavioral characteristics of participants. Chart abstraction data will be used to record details of the patient's hospital stay. Patients and family members wil complete additional survey assessments 6 months after discharge. A subset of patients and family members will participate in in-depth qualitative interviews. The study had 3 specific aims: 1) To determine the patient characteristics that are associated with positive psychological adaptation in patient survivors of acute respiratory failure; 2) to determine the family characteristics and ICU processes of care that are associated with positive psychological adaptation in family members; and 3) to determine the association between patient and family psychological adaptation and patient and family long-term outcomes including quality of life, adverse psychological symptoms and healthcare utilization. This application offers an opportunity to expand the body of knowledge regarding patient and family quality of life after acute respiratory failure by identifying novel associations between psychosocial and behavioral characteristics, psychological adaptation, and long-term outcomes which will lead to development of interventions focused on improving outcomes for critically ill patients and their family members.